Available evidence about the relationship between poor insight and other clinical characteristics in patients
with obsessive–compulsive disorder (OCD) is inconclusive and conflicting. There is also a paucity of data on
the long-term course and treatment outcome of OCD patients with poor insight. The present study reports
the findings of a relatively large sample (n=106) of outpatients fulfilling DSM-IV criteria for OCD, treated
with serotonin reuptake inhibitors (SRIs) and prospectively followed up for 3 years. Baseline information
was collected on demographic and clinical characteristics, using standardized instruments. Insight was
assessed by means of the Brown Assessment of Beliefs Scale (BABS). Eighty-three patients were followed
prospectively and evaluated systematically by validated measures of psychopathology. Compared to their
good insight counterparts, the OCD patients with poor insight (22%) showed a greater severity of obsessive–
compulsive and depressive symptomatology; an earlier age at onset; a higher rate of schizophrenia spectrum
disorder in their first-degree relatives; a higher comorbidity with schizotypal personality disorder. During
the follow-up period, poor insight OCD patients were less likely to achieve at least a partial remission of
obsessive–compulsive symptoms; required a significantly greater number of therapeutic trials; received
more frequently augmentation with antipsychotics. The results suggest that the specifier “poor insight” helps
to identify a subgroup of patients at the more severe end of OCD spectrum, characterized by a more complex
clinical presentation, a diminished response to standard pharmacological interventions, and a poorer
prognosis. Further research is needed to identify alternative strategies for the management of these patients.

Available evidence about the relationship between poor insight and other clinical characteristics in patients
with obsessive–compulsive disorder (OCD) is inconclusive and conflicting. There is also a paucity of data on
the long-term course and treatment outcome of OCD patients with poor insight. The present study reports
the findings of a relatively large sample (n=106) of outpatients fulfilling DSM-IV criteria for OCD, treated
with serotonin reuptake inhibitors (SRIs) and prospectively followed up for 3 years. Baseline information
was collected on demographic and clinical characteristics, using standardized instruments. Insight was
assessed by means of the Brown Assessment of Beliefs Scale (BABS). Eighty-three patients were followed
prospectively and evaluated systematically by validated measures of psychopathology. Compared to their
good insight counterparts, the OCD patients with poor insight (22%) showed a greater severity of obsessive–
compulsive and depressive symptomatology; an earlier age at onset; a higher rate of schizophrenia spectrum
disorder in their first-degree relatives; a higher comorbidity with schizotypal personality disorder. During
the follow-up period, poor insight OCD patients were less likely to achieve at least a partial remission of
obsessive–compulsive symptoms; required a significantly greater number of therapeutic trials; received
more frequently augmentation with antipsychotics. The results suggest that the specifier “poor insight” helps
to identify a subgroup of patients at the more severe end of OCD spectrum, characterized by a more complex
clinical presentation, a diminished response to standard pharmacological interventions, and a poorer
prognosis. Further research is needed to identify alternative strategies for the management of these patients.